The Effectiveness of Colonoscopy in Reducing Mortality From Colorectal Cancer
Authors: Perry J. Pickhardt
Journal: Annals of Internal Medicine (2009)

Letters2 June 2009The Effectiveness of Colonoscopy in Reducing Mortality From Colorectal CancerPerry J. Pickhardt, MD, David H. Kim, MD, and Cesare Hassan, MDPerry J. Pickhardt, MDFrom University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, and “Nuovo Regina Margherita” Hospital, Rome, Italy.Search for more papers by this author, David H. Kim, MDFrom University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, and “Nuovo Regina Margherita” Hospital, Rome, Italy.Search for more papers by this author, and Cesare Hassan, MDFrom University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, and “Nuovo Regina Margherita” Hospital, Rome, Italy.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-11-200906020-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read with interest the recent article by Baxter and colleagues (1). This landmark article demonstrated a clear benefit of colonoscopy for left-sided colorectal cancer but failed to show any survival benefit for right-sided colorectal cancer. Plausible explanations for this important observation include unique tumor biology for a subset of right-sided colorectal cancer and technical factors resulting in missed right-sided colorectal cancer by colonoscopy. In fact, an alternate cancer pathway distinct from the typical adenoma–carcinoma sequence—the serrated polyp pathway—has been identified. The serrated polyp pathway is a predominately right-sided process and may account for 15% of sporadic ...References1. Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009;150:1-8. [PMID: 19075198] LinkGoogle Scholar2. Pickhardt PJ, Nugent PA, Mysliwiec PA, Choi JR, Schindler WR. Location of adenomas missed by optical colonoscopy. Ann Intern Med. 2004;141:352-9. [PMID: 15353426] LinkGoogle Scholar3. Pickhardt PJ, Choi JR, Hwang I, Butler JA, Puckett ML, Hildebrandt HA, et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med. 2003;349:2191-200. [PMID: 14657426] CrossrefMedlineGoogle Scholar4. Kim DH, Pickhardt PJ, Taylor AJ, Leung WK, Winter TC, Hinshaw JL, et al. CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med. 2007;357:1403-12. [PMID: 17914041] CrossrefMedlineGoogle Scholar5. Johnson CD, Fletcher JG, MacCarty RL, Mandrekar JN, Harmsen WS, Limburg PJ, et al. Effect of slice thickness and primary 2D versus 3D virtual dissection on colorectal lesion detection at CT colonography in 452 asymptomatic adults. AJR Am J Roentgenol. 2007;189:672-80. [PMID: 17715116] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, and “Nuovo Regina Margherita” Hospital, Rome, Italy.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLocation of Adenomas Missed by Optical Colonoscopy Perry J. Pickhardt , Pamela A. Nugent , Pauline A. Mysliwiec , J. Richard Choi , and William R. Schindler Association of Colonoscopy and Death From Colorectal Cancer Nancy N. Baxter , Meredith A. Goldwasser , Lawrence F. Paszat , Refik Saskin , David R. Urbach , and Linda Rabeneck The Effectiveness of Colonoscopy in Reducing Mortality From Colorectal Cancer Joseph Romagnuolo , Alan N. Barkun , and Amee R. Manges The Effectiveness of Colonoscopy in Reducing Mortality From Colorectal Cancer Nancy N. Baxter and Linda Rabeneck The Effectiveness of Colonoscopy in Reducing Mortality From Colorectal Cancer Jordan J. Karlitz The Effectiveness of Colonoscopy in Reducing Mortality From Colorectal Cancer Sanford D. Markowitz , Steven H. Itzkowitz , and Barry M. Berger The Effectiveness of Colonoscopy in Reducing Mortality From Colorectal Cancer Amit Gupta and David A. Ahlquist The Effectiveness of Colonoscopy in Reducing Mortality From Colorectal Cancer Noel S. Weiss and V. Paul Doria-Rose The Effectiveness of Colonoscopy in Reducing Mortality From Colorectal Cancer Stephen M. Picca Metrics Cited byDiagnostic yield of flexible sigmoidoscopy and CTCLeft-sided Polyps Detected at Screening CT Colonography: Do We Need Complete Optical Colonoscopy for Further Evaluation?La coloscopie en France en 2008: résultats de l’enquête de deux jours d’endoscopie en France 2 June 2009Volume 150, Issue 11Page: 818-819KeywordsCancer screeningColonColonoscopyColorectal cancerComputed axial tomographyConflicts of interestEndoscopyLesions ePublished: 2 June 2009 Issue Published: 2 June 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...